Hepatic Venous Congestion And Liver Regeneration Of Donor-recipients After Living Donor Liver Transplantation: Multi-slice Spiral CT Study

Objective To evaluate correlations between multi-slice spiral CT (MSCT)volumetric measurement and actual volume and weight of graft in living donor livertransplantation (LDLT), and the repeatability of MSCT volumetric measurement. Toevaluate the reasons, extent and prognosis of hepatic venous congestion (HVC) afterLDLT using MSCT. To evaluate the liver regeneration and the influencing factors atthe different stages after LDLT using MSCT.Materials and Methods 91 living donors, 153 and 120 living donor-recipientswere included in this study, 10 healthy volunteers were included as controls in CTperfusion examination. We did CT volumetric measurement of the liver by using thehand tracing method. Intraoperatively, the weight and volume of graft were recorded,correlation coefficient and linear regressions were calculated. Images were evaluatedfor hepatic attenuation difference and congestive reasons in areas of hepatic venouscongestion. Preoperative estimation of congestion volumes were correlated with theactual congestion volume after LDLT. Blood volume (BV), blood flow (BF), meantransit time (MTT), permeability surface (PS) and hepatic arterial fraction (HAF) ofcontrols, congestive areas and non-congestive areas were recorded, respectively.Gutamic pyruvic transaminase (GPT), glutamic oxalacetic transaminase (GOT), totalbilirubin (TB) and prothrombin time (PT) of 1 to 7 days after LDLT betweencongestion group and non-congestion group were recorded and compared. The liverregenerative ratio (LRR) of different stages of donor-recipients after LDLT werecalculated and compared, correlation coefficient and linear regressions werecalculated.Results Preoperative measurement of total liver and grafts resulted in a meanvolume of 1366.99±234.75cm³ (standard deviation) and 862.73±175.94cm³ (V_preop),respectively, and the volume of grafts was measured by the second gauger was843.15±171.39cm³. Intraoperative mean weight and volume of the grafts were710.70±150.25g (W_intraop) and 654.46±151.23m1 (V_intraop), respectively. Allcorresponding pre- and intraoperative data correlated significantly with each other.V_intraop and W_intraop can be calculated with the equations V_intraop =64.949+(0.683× V_preop) ml and W_intraop=78.609+(0.733×V_preop)g, respectively. HVC often appear ashypoattenuation on plain CT scan (51.02%) and arterial phase (36.73%), mixed(63.27%) or hyperattenuation (34.69%) on portal vein phase. Persistenthypoattenuation on arterial phase and portal vein phase indicated severe HVC. Therewas no significantly difference between preoperative estimation of congestionvolumes and the actual congestion volume in donors (P＞0.05). Compared withcontrols, BV, BF and HAF of congestive areas were significantly increased (P＜0.05).There were no significantly difference of GPT, GOT, TB and PT after LDLT betweencongestion group and non-congestion group (P＞0.05). There were significantlydifference of LRRs between different stages of donors and recipients (P＜0.05). Thefollowing factors, included whether the graft contain MHV or not, age and sex ofdonor-recipients, had no significant influence on LRR after LDLT (P＞0.05). Thestatus of liver function of recipients preoperatively had significant influence on LRRof early stage after LDLT (P＜0.05). There were significantly negative correlationbetween the residual or graft volume and LRRs of donor-recipients at different stagesafter LDLT.Conclusion The repeatability of MSCT volumetric measurement are good. Byusing two equations, expected intraoperative weight and volume can properly bedetermined. It is accurate to evaluate the reasons, extent and prognosis of HVC byusing MSCT. Reconstruction of blood vessel can significantly improve HVC. It issignificantly faster and reach a higher peak of LRRs in recipients than in donors. Thefollowing factors, included whether the graft contain MHV or not, age and sex ofdonor-recipients, have no significant influence on LRR after LDLT. The status ofliver function of recipients preoperatively has significant influence on LRR of earlystage after LDLT. The residual or graft volume has significant influence on LRR afterLDLT. At different stages, we get different regression equations to evaluate LRR andthe influence fractors in donor-recipients.